• Journal of the Korean Orthopaedic Association
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• v.56 no.6
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• pp.491-497
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• 2021

Purpose: To investigate the prevalence of osteoporosis or osteopenia via dual-energy X-ray absorptiometry bone mineral density (DEXA BMD) in adult males who showed radiolucent lumbar vertebra on the plain radiographs. Materials and Methods: The DEXA BMD values of 98 adult males, who showed radiolucent vertebrae on plain X-rays, were compared with those of the control group (n=168) and osteoporosis-related fracture group (n=113) by statistical analysis. The World Health Organization (WHO) method (lower value between the mean lumbar and femur neck) and the Hansen's method (lowest lumbar vertebra) were used to determine osteoporosis. Results: The mean and standard deviation of the BMD value of each group was -1.4 (±1.2) in the suspicious group, -0.8 (±1.1) in the control group, and -2.4 (±1.0) in the fracture group, respectively; the difference was statistically significant. Using the WHO method, the prevalence ratio of osteoporosis was 17.3% in the suspicious group, 8.3% in the control group, and 45.1% in the fracture group, respectively. Osteopenia was observed in 40.8% of the suspicious group. Hansen's method (lowest lumbar vertebra) revealed the prevalence of osteoporosis in 30.6% of the suspicious group, 17.9% of the control group, and 62.0% of the fracture group. Conclusion: Approximately 17.3% of the suspicious group was diagnosed with osteoporosis, and 40.8% were osteopenic by a confirmative BMD study (WHO criteria) among the adult males showing apparent radiolucency on plain X-rays. The control group also showed an 8% prevalence of osteoporosis. These results suggest that males also are vulnerable to osteoporosis. Therefore, a BMD study should also be used for males, especially for the people showing lumbar vertebrae with radiolucent features.

• Journal of the Korean Orthopaedic Association
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• v.55 no.6
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• pp.487-494
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• 2020

Purpose: No attempt has been made to identify the relationship between the study characteristics and citation rates of articles published in the Journal of the Korean Orthopaedic Association (JKOA). This study classified the study characteristics of articles in the JKOA and analyzed the relationship between the study characteristics and citation rates. Materials and Methods: A cohort study was conducted on all articles published from February 2001 to December 2015. Three independent reviewers classified the articles according to the article type, material, time of the study, design, clinical categories, number of authors, and number of cases. The citation numbers of each article by other journals were taken in January 2020. Univariate analyses were conducted to assess the effect of each characteristic, and multivariate linear regression analysis was performed to analyze the overall relationship between the characteristics and the citation rates. Results: A total of 1,640 articles were published from 2001 to 2015, and 724 articles were cited more than once. The articles published in 2009 had the highest average number of citations. Original articles had the highest citation rates, followed in descending order by surgical techniques and reviews, instructional course lectures, and case reports (p<0.001). Among the case reports, articles dealing with general trauma scored significantly higher average citations (mean=1.5, p=0.006). Among the original articles, articles on general orthopedics had the highest citation rates, followed in order by clinical articles and experimental articles. Among the clinical articles, epidemiologic studies (mean=5.0, p<0.001) and studies on the spine (mean=1.7, p<0.001) recorded significantly higher citation rates than the others. Conclusion: Of all the articles published in the JKOA from 2001 to 2015, articles dealing with general trauma had the highest citation rates among case reports. Among the original articles, epidemiologic studies and studies concerning the spine were cited significantly more than others.

• Journal of the Korean Orthopaedic Association
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• v.56 no.2
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• pp.150-156
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• 2021

Purpose: To determine how the location, displacement, intra-articular involvement, comminution of a 5th metatarsal base fracture affect results of early weight-bearing treatment. Materials and Methods: From January 2013 to July 2017, 34 cases of 34 patients diagnosed with a fracture of the zone I and II 5th metatarsal base were enrolled. The mean follow-up period was 13 months (6-15 months). One patient was excluded as a refracture during the follow-up period, and 33 patients underwent conservative treatment. Anteroposterior, lateral, and simple oblique radiography and computed tomography of the foot were performed to evaluate the location and displacement of the fracture, the degree of joint involvement, and comminution. In all 33 patients, a short leg cast or boot brace was selected immediately after the injury, tolerable weight bearing was allowed. If the pain disappeared, full weight bearing was performed after wearing a plain shoe or postoperative shoe. As a clinical result, the American Orthopedic Foot and Ankle Society (AOFAS) score was evaluated at the final follow-up. During outpatient follow-up, a simple radiograph of the foot was taken to confirm the time of radiological bone union and return to work. Results: Nine males and 24 females, with an average age of 48.7 years, were enrolled in the study. Twenty-four patients had zone I fractures, and nine patients had zone II fractures. Twenty-two out of 33 patients had a fracture displacement of 2 mm or more. Nine and five patients had joint involvement and comminution, respectively. There was a statistically significant return to work from zone I to zone II. The AOFAS score was excellent at the final follow-up and there was no significant difference. When classifying and comparing the degree of fracture displacement, joint involvement, and comminution, there were no significant differences in the radiological union time and return to work. In all cases, satisfactory results were obtained at the final follow-up. Conclusion: Satisfactory clinical results can be obtained by allowing early weight-bearing regardless of the fracture location, displacement, joint involvement, or comminution in zone I and II 5th metatarsal base fractures.

• Journal of the Korean Orthopaedic Association
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• v.55 no.1
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• pp.71-77
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• 2020

Purpose: To determine if sparing the interspinous and supraspinous ligaments during posterior decompression for lumbar spinal stenosis is significant in preventing postoperative spinal instability. Materials and Methods: A total of 83 patients who underwent posterior decompression for lumbar spinal stenosis between March 2014 and March 2017 with a minimum one-year follow-up period, were studied retrospectively. The subjects were divided into two groups according to the type of surgery. Fifty-six patients who underwent posterior decompression by the port-hole technique were grouped as A, while 27 patients who underwent posterior decompression by a subtotal laminectomy grouped as B. To evaluate the clinical results, the Oswestry disability index (ODI), visual analogue scale (VAS) for both back pain (VAS-B) and radiating pain (VAS-R), and the walking distance of neurogenic intermittent claudication (NIC) were checked pre- and postoperatively, while simple radiographs of the lateral and flexion-extension view in the standing position were taken preoperatively and then every six months after to measure anteroposterior slippage (slip percentage), the difference in anteroposterior slippage between flexion and extension (dynamic slip percentage), angular displacement, and the difference in angular displacement between flexion and extension (dynamic angular displacement) to evaluate the radiological results. Results: The ODI (from 28.1 to 12.8 in group A, from 27.3 to 12.3 in group B), VAS-B (from 7.0 to 2.6 in group A, from 7.7 to 3.2 in group B), VAS-R (from 8.5 to 2.8 in group A, from 8.7 to 2.9 in group B), and walking distance of NIC (from 118.4 m to 1,496.2 m in group A, from 127.6 m to 1,481.6 m in group B) were improved in both groups. On the other hand, while the other radiologic results showed no differences, the dynamic angular displacement between both groups showed a significant difference postoperatively (group A from 6.2° to 6.7°, group B from 6.5° to 8.4°, p-value=0.019). Conclusion: Removal of the posterior ligaments, including the interspinous and supraspinous ligaments, during posterior decompression of lumbar spinal stenosis can cause a postoperative increase in dynamic angular displacement, which can be prevented by the port-hole technique, which spares these posterior ligaments.

• Journal of the Korean Orthopaedic Association
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• v.55 no.2
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• pp.127-134
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• 2020

Purpose: The aims of this study were (1) to investigate the relationship between the characteristics of allogenic bone block and the compressive strength of an allogenic bone block measured by biomechanical experiments, and (2) to compare the maximum pressure load of allogenic bone block with the gap pressure measured at the high tibial opening osteotomy. Materials and Methods: Ten patients who provided informed consent for gap pressure measurements during opening wedge high tibial osteotomy (OWHTO) were included. The gap pressures were measured at 1 mm intervals while opening the osteotomy site from 8 mm to 14 mm. Seventeen U-shaped allogenous wedge bone blocks were made from the femur, tibia, and humerus. The height, width, cross-sectional area, and cortex thickness of the bone blocks were measured, along with the maximum compressive load just before breakage. The relationship between these characteristics and the maximum pressure load of the bone blocks was evaluated. The gap pressures measured in OWHTO were compared with the maximum pressure loads of the allogenous wedge bone blocks to evaluate the possibility of inserting allogenous wedge bone blocks into the osteotomy site without a distractor in OWHTO. Results: The OWHTO gap pressure increased with increasing osteotomy site opening. The mean gap pressure, which occurred at a 14-mm opening, was 282±93 N; the maximum pressure was 427 N. The maximum pressure load of the allografts was 13,379±6,469 N (minimum, 5,868; maximum, 29,130 N) and was correlated significantly with the cortical bone thickness (correlation coefficient=0.693, p=0.002) and cross-sectional area (correlation coefficient=0.826, p<0.001). Depending on the sterilization method, the maximum pressure loads for the bone blocks were 13,406±5,928 N for freeze-dried and 13,348±7,449 N for fresh frozen. The maximum compressive load of the allogenous wedge bone blocks was 13.7-times greater than that in OWHTO opened to 14 mm (5,868 N vs. 427 N). Conclusion: The compressive strength of allogenous wedge bone blocks was sufficiently greater than the gap pressure in OWHTO. Therefore, allogenous wedge bone blocks can be inserted safely into the osteotomy site without a distractor.

• Journal of the Korean Orthopaedic Association
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• v.55 no.6
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• pp.495-502
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• 2020

Purpose: The aim of this study was to assess the effectiveness of domestically developed volar locking plate which has the concept of double-tiered subchondral support (DSS) in maintaining the reduction after distal radial fracture surgery. Materials and Methods: From July 2017 to December 2018, 54 patients were assessed. Plain radiographs were obtained immediately after surgery and at the last follow-up, and the radiographic parameters were measured in those images: radial length, radial inclination, volar tilt, ulnar variance, and distal dorsal cortical distance. The patients were subdivided into their age, type of fracture, and the position of the plate to evaluate the influence of each factors on the reduction maintenance. Results: Distal dorsal cortical distance in radiographs after the surgery was 5.91 mm (standard deviation, ±1.95 mm) on average. Significant differences in the radial length (p=0.038) and ulnar variance (p=0.001) were observed between immediately after surgery and at the last follow-up. When the parameters were evaluated by dividing the patients into subgroups according to the three specific factors, the ulnar variance showed a significant increase at the last follow-up when the patients were included 65-years-old or older. AO/OTA type C3 fracture, and Soong classification grade 0 plate position (p=0.007, p=0.012, p=0.046, respectively). Conclusion: Using the domestically developed DSS-type volar locking plate, significant reduction after distal radial fracture surgery could be maintained successfully. On the other hand, further study will be needed to determine about the reduction loss of the lunate facet identified in special cases that deal with fractures in elderly patients, unstable AO/OTA type C3 distal radial fractures, and Soong classification grade 0 plate position.

• The Korean Journal of Nuclear Medicine Technology
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• v.26 no.1
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• pp.27-32
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• 2022

Purpose When performing a whole-body bone scan, many patients are experiencing psychological difficulties due to the close distance to the detector. Recently, in the medical field, there is a report that using virtual reality (VR) equipment can give pain relief to pediatric patients with weak concentration or patients receiving severe treatment through a distraction method. Therefore, in this paper, VR equipment was used to provide psychological stability to patients during nuclear medicine tests, and it is intended to evaluate whether it can be used in clinical practice. Materials and Methods As VR equipment, ALLIP Z6 VR (ALLIP, Korea) was used and the experiment was conducted after connecting to a mobile phone. The subjects were 30 patients who underwent whole-body bone examination from September 1, 2021 to September 30, 2021. After intravenous injection of 99mTc-HDP, 3 to 6 hours later, VR equipment was put on and whole body images were obtained. After the test, a survey was conducted, and a Likert scale of 5 points was used for psychological anxiety and satisfaction with VR equipment. Hypothesis verification and reliability of the survey were analyzed using SPSS Statistics 25 (IBM, Corp., Armonk, NY, USA). Results Anxiety about the existing whole-body bone test was 3.03±1.53, whereas that of anxiety after wearing VR equipment was 2.0±1.21, indicating that anxiety decreased to 34%. When regression analysis of the effect of the patient's concentration on VR equipment on anxiety about the test, the B value was 0.750 (P<0.01) and the t value was 6.181 (P<0.01). decreased and showed an influence of 75%. In addition, overall satisfaction with VR equipment was 3.76±1.28, and the intention to reuse was 66%. The Cronbach α value of the reliability coefficient of the questionnaire was 0.901. Conclusion When using VR equipment, patients' attention was dispersed, anxiety was reduced, and psychological stability was found. In the future, as VR equipment technology develops, it is thought that if the equipment can be miniaturized and the resolution of VR content images is increased, it can be used in various clinical settings if it provides more realistic stability to the patient.

• The Korean Society of Law and Medicine
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• v.23 no.1
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• pp.37-80
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• 2022

By analyzing informed consent and the refusal of emergency medical treatment (called patient dumping) under the current Emergency Medical Service Act, this study suggests that an emergency medical professional is only liable for patient dumping if their duty to protect the patient's life takes precedence over the patient's right to self-determination. In emergency medical situations, as in general medical situations, medical treatment should be performed after the emergency medical professional informs the patient about the medical treatment, including its necessity and methods, and obtains consent from the patient. Refusing or evading the performance of emergency medical services on the excuse of the informed consent not considering a waiver or alteration of informed consent requirements without reasonable reasons violates the Emergency Medical Service Act and thus makes an emergency medical professional liable to administrative disposition or criminal penalty. In other words, depending on the existence of a waiver of alteration of the informed consent, patient dumping may be established. If the patient is a minor or has no decision-making ability, and their legal representative makes a decision against the patient's medical interests, the opinion of the legal representative is not unconditionally respected. A minor also has the right to decide over their body, and the decisions of their legal representatives should be in the patient's best interests. If the patient refuses treatment, in principle, the obligation of life protection of emergency medical professionals is the top priority. However, making these decisions in the aforementioned situations in the emergency medical field is difficult because of the absence of explicit regulations regarding these exceptional problems. This study aims to organize the following precedents of the Supreme Court of Korea. The court states that, when balancing the conflicting interests between the duty to provide emergency medical service and the duty to inform is unavoidable for emergency medical professionals, they should put the duty to protect the patient's life ahead of the duty to inform if the patient's life matters. Exceptionally, when a patient has seriously considered whether they should receive treatment before the emergency medical situation, their right to self-determination can be considered equal to the obligation of emergency medical professionals to provide emergency medical treatment. This research also suggests that an amendment of the Emergency Medical Service Act should include the following. First, the criteria for determining the decision-making ability of emergency patients should consist of medical content. Second, additional consent from a medical professional is unnecessary for first-aid treatment. Finally, new provisions for emergency medical obligations for minors, new provisions for the decision standard when there are conflicting opinions about the treatment of a patient, and new penalty provisions for professionals who suspend emergency medical examinations and treatments need to be established.

• Journal of Korea Water Resources Association
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• v.54 no.spc1
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• pp.1095-1105
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• 2021

The advancement of dam operation is further required due to the upcoming rainy season, typhoons, or torrential rains. Besides, physical models based on specific rules may sometimes have limitations in controlling the release discharge of dam due to inherent uncertainty and complex factors. This study aims to forecast the water level of the nearest station to the dam multi-timestep-ahead and evaluate the availability when it makes a decision for a release discharge of dam based on LSTM (Long Short-Term Memory) of deep learning. The LSTM model was trained and tested on eight data sets with a 1-hour temporal resolution, including primary data used in the dam operation and downstream water level station data about 13 years (2009~2021). The trained model forecasted the water level time series divided by the six lead times: 1, 3, 6, 9, 12, 18-hours, and compared and analyzed with the observed data. As a result, the prediction results of the 1-hour ahead exhibited the best performance for all cases with an average accuracy of MAE of 0.01m, RMSE of 0.015 m, and NSE of 0.99, respectively. In addition, as the lead time increases, the predictive performance of the model tends to decrease slightly. The model may similarly estimate and reliably predicts the temporal pattern of the observed water level. Thus, it is judged that the LSTM model could produce predictive data by extracting the characteristics of complex hydrological non-linear data and can be used to determine the amount of release discharge from the dam when simulating the operation of the dam.

• Journal of Nutrition and Health
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• v.55 no.2
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• pp.278-295
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• 2022

Purpose: This study was undertaken to revise and update the Nutrition Quotient (NQ) for Korean adults, a tool used to evaluate dietary quality and behavior. Methods: The first 31 items of the measurable food behavior checklist were adopted based on considerations of the previous NQ checklist, recent literature reviews, national nutrition policies, and recommendations. A pilot survey was conducted on 100 adults aged 19 to 64 residing in Seoul and Gyeonggi Province from March to April 2021 using a provisional 26- item checklist. Pilot survey data were analyzed using factor analysis and frequency analysis to determine whether checklist items were well organized and responses to questions were well distributed, respectively. As a result, the number of items on the food behavior checklist was reduced to 23 for the nationwide survey, which was administered to 1,000 adults (470 men and 530 women) aged 19 to 64 from May to August 2021. The construct validity of the developed NQ (NQ-2021) was assessed using confirmatory factor analysis, linear structural relations. Results: Eighteen items in 3 categories, that is, balance (8 items), moderation (6 items), and practice (4 items), were finally included in NQ-2021 food behavior checklist. 'Balance' items addressed the intake frequencies of essential foods, 'moderation' items the frequencies of unhealthy food intakes or behaviors, and 'practice' items addressed eating behaviors. Items and categories were weighted using standardized path coefficients to calculate NQ-2021 scores. Conclusion: The updated NQ-2021 appears to be suitable for easily and quickly assessing the diet qualities and behaviors of Korean adults.